VIRGINIA DEPARTMENT OF SOCIAL SERVICES

Sancerre Atlee Station
9495 Atlee Road
Mechanicsville, VA 23116
(804) 729-9200

Current Inspector: Yvonne Randolph (804) 662-7454

Inspection Date: March 5, 2024

Complaint Related: No

Areas Reviewed:

22VAC40-73 STAFFING AND SUPERVISION 22VAC40-73 RESIDENT CARE AND RELATED SERVICES 22VAC40-73 ADDITIONAL REQUIREMENTS FOR FACILITIES THAT CARE FOR ADULTS WITH SERIOUS COGNITIVE IMPAIRMENTS

Comments:

Type of inspection: Monitoring Date and time that the licensing inspector was on-site at the facility for each day of the inspection: 3/5/24 The Acknowledgement of Inspection form was emailed for each date of the inspection. Number of residents present at the facility at the beginning of the inspection: Number of resident records reviewed: 1 Number of staff records reviewed: 0 Number of interviews conducted with residents: 1 Number of interviews conducted with staff: 5 Observations by licensing inspector: Staffing, resident/staff interaction Additional Comments/Discussion: Interviews held with a family member and staff on duty the day of the incident. An exit meeting was conducted to review the inspection findings. The evidence gathered during the investigation supported the non-compliance with standard(s) or law, and a violation was issued. Any violation(s) not related to the self report but identified during the course of the investigation can also be found on the violation notice. The licensee has the opportunity to submit a plan of correction to indicate how the cited violation(s) will be addressed in order to return the facility to compliance and maintain future compliance with applicable standard(s) or law. If the licensee wishes to provide a plan of correction: (i) type the plan on a separate Word document, (ii) identify the standard violation number being addressed, (iii) include the date the violation will be corrected, (IV) do not include any names or confidential information, and (V) return to the licensing inspector by email within five (5) business days of the exit interview. Compliance with all applicable regulations and law shall be maintained and any areas of noncompliance must be corrected. Within 15 calendar days of your receipt of the inspection findings (inspection summary, violation notice, and supplemental information), you may request a review and discussion of these findings with the inspector's immediate supervisor. To make a request for review and discussion, you must contact the licensing supervisor at the regional licensing office that serves your geographical area. Regardless of whether a supervisory review has been requested, the results of the inspection will be posted to the DSS public website within 5 business days of your receipt of the Inspection Summary and/ or Violation Notice. The department's inspection findings are subject to public disclosure. Please Note: A copy of the findings of the most recent inspection are required to be posted on the premises of the facility. For more information about the VDSS Licensing Programs, please visit: www.dss.virginia.gov Should you have any questions, please contact Yvonne Randolph, Licensing Inspector at 804-662-7454 or by email at yvonne.randolph@dss.virginia.gov

Violations:

Standard #:	22VAC40-73-460-A
Description:	Based on an investigation of a self-reported incident, the facility did not assume general responsibility for the health, safety and welfare of a resident. Evidence: 1. The facility self-reported a resident to resident altercation on 1/28/24 in the common area of the memory care environment. The self-report documented that resident # 1 was hit by a pillow and fell face first to the floor resulting in injuries to the face. (photo taken of injuries) 2. Resident # 1 was transported to a local ER and had a CT face scan that documented head injury with facial fracture and a CT head scan that documented fall with sdh/sah (subdural hematoma and subarachnoid hemorrhage). 3. Interviews with staff on duty at the time of the fall did not support that staff was physically present within an immediate distance of the residents in the common area to prevent the fall or altercation. a. Staff # 3 stated during her interview that she did not observe the incident or fall as she was assisting a resident in the resident?s room. b. Staff # 4 stated during her interview that she did not observe the incident or fall as she was not in the area. c. Staff # 5 stated during her interview that she was walking out of the kitchen area when the incident and fall occurred.
Plan of Correction:	1 Continue to support the staff in early interventions with resident behaviors. 2. Staff Training: Staff members who currently support Memory Care residents shall receive training on addressing aggressive behavior between residents, to promote early interventions. 3. Oversight Enhancement: The newly hired community?s Memory Care Director, or their designee, shall help manage oversight of resident care. The community?s Memory Care Director, or their designee, shall provide guidance and support to staff in ensuring that residents' needs are met, and potential incidents are addressed promptly.